CARE HOME ADULTS 18-65
Chesterfield Gardens 80 London N4 1LR Lead Inspector
Susan Shamash Unannounced Inspection 26th January 2006 11:00 Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chesterfield Gardens 80 Address London N4 1LR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8350 6468 Mr Phivos Joannides Mr Phivos Joannides Care Home 4 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (4), Mental disorder, excluding of places learning disability or dementia (4), Mental Disorder, excluding learning disability or dementia - over 65 years of age (4) Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30/06/05 Brief Description of the Service: This home is registered for four people who have a learning disability or mental health needs. There are three men currently living in the home. All have mental health needs. There are four single bedrooms but currently two men have chosen to share a room. The other bedroom has been temporarily turned into a lounge for these two men to share. The home includes one bedroom with en suite facilities, and two shared bathrooms. There is an office on the ground floor, which is also used as a staff sleeping-in room, and front and rear gardens. The house is situated close to Green Lanes, with easy access to public transport and local amenities. The home is one of a number locally, owned and managed by the Joannides family. This home is owned by Mr. Phivos Joannides who is also the registered manager. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was undertaken on an unannounced basis and lasted approximately five hours. There was one member of care staff on duty in the home when the inspector arrived and the managers from two of other homes owned by the provider also provided every assistance to the inspector. The registered manager of the home was abroad at the time of the inspection. Since the previous inspection, the home had been successful in an application to increase the number of residents from three to four, however no new resident had yet been admitted to the home. The inspector had the opportunity to speak to two of the three residents who are living in the home (one at some length whilst the other only wished to talk briefly). The other resident was out at day care services during the inspection. A tour of the building was conducted and residents’, staff and health and safety records were inspected. What the service does well: What has improved since the last inspection?
Since the previous inspection, works had been undertaken to extend the home to include a further bedroom, increased communal space and a further bathroom and toilet. Fourteen requirements were made at the previous inspection. Eight of these related to requirements from the inspection before that, which could not be
Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 6 verified due to work being undertaken at the home. As required, evidence was provided that the social workers for two identified residents had been contacted in order to attempt to arrange Care Programme Approach reviews. Greater detail was provided with regard to support provided for residents with their finances, although a new requirement is made regarding this. A list of specimen signatures of staff administering medication to residents, was now available, and staff were aware of how to record mistakes on medication administration records. Immediate requirements relating to the storage of food and medicines during the building works, had been met to ensure the protection of residents. The ground floor of the home and the shared residents’ room had been redecorated as appropriate and all fire doors were found to be self-closing. A reference from the last or current employer for any prospective staff is now being sought prior to employment, and regular supervision sessions are being provided to all staff in the home. Evidence was provided that the registered manager is undertaking appropriate NVQ training. Staff had undertaken training in fire safety, adult protection, first aid, challenging behaviour, control of substances hazardous to health, diet and nutrition, and dying and bereavement. As required the hot water temperature in the kitchen was found to be appropriate and evidence was provided that the appropriate level of insurance cover is in place for the home. What they could do better:
It is recommended that an additional symbol be introduced for use on medication administration records to indicate that medicines have not been taken (for a reason other than those currently specified) accompanied by an explanation e.g. the resident was asleep. It remains required that all staff undertake training in working with people with mental health problems. Finally the manager must write to the placing authority of the identified resident, advising them that they are unable to receive payment of the resident’s monies into the home’s business account as this is illegal. Alternatives to this arrangement must be sought e.g. setting up a client account for the resident. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Information is available for prospective service users to make a decision about whether to move into the home. An adequate system is in place to assess service users’ needs and goals effectively and ensure that these can be met. EVIDENCE: Since the previous inspection, the home had been successful in an application to increase the number of service users from three to four, however no new service user had yet been admitted to the home. The statement of purpose and service users guide for the home had been updated appropriately and copies were provided to the inspector. There have been no new admissions since the last inspection. The inspector had the opportunity to talk with two service users, and both indicated that their needs were being met appropriately. The third service user was out at a day centre during the inspection. Records indicated that each service users had been assessed and placed appropriately at the home, and all are well settled within the home. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Service users’ changing needs and goals are assessed and responded to appropriately, taking account of their preferences. They are supported to take appropriately assessed risks in order to develop independence skills. EVIDENCE: Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 11 Service users spoken to indicated that their needs were being met at the home according to their choices. Care plans were available for each service user with evidence of regular reviews as appropriate. As required at the previous inspection, evidence was available that the local placing authority for two service users at the home had been contacted on a number of occasions in order to request a review of their needs. Letters indicated that these had not yet been undertaken due to staff shortages at the local authority. The level of detail recorded in service user plans regarding the management of their financial affairs, had been improved however a requirement is made regarding this issue under Standard 41. Appropriate risk assessments were available for each service user, and these specified agreed actions to be taken to minimise the risks to service users whilst promoting their independence as far as possible. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. A range of activities are available for service users both within and outside of the home. Freedom is provided for service users to engage in personal relationships and maintain contact with family and friends. They are encouraged to be involved in all aspects of home life, and are provided with a varied selection of meals that meet their nutritional needs. EVIDENCE: Service users living in the home are generally quite independent and able to say what they like and don’t like, coming and going unaccompanied. One service user attends a supported workshop where they make and sell items, and also attends a computer course at a local college on a part time basis. Another attends a day centre run by the charity Mind, in the mornings, whilst the other advised that they consider themself to be semi-retired. Service users spoken to advised that they had enjoyed a trip to the coast over the summer.
Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 13 Staff and service users confirmed that service users are encouraged to maintain family links and beneficial friendships. They advised that they were satisfied with food served at the home. The menu indicated that a varied and balanced diet is provided. As required at the previous inspection, action had been taken to ensure that service users do not store perishable foods e.g. milk, cheese and butter in their bedrooms, due to the risk of food poisoning. This had been addressed appropriately. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Service users receive appropriate physical and emotional support in accordance with their preferences. They are supported to take their prescribed medicines to ensure medication needs are met. EVIDENCE: Service users are mainly independent with regard to their personal care. They told the inspector that they have appropriate access to healthcare services. Service user plans included details of their preferences in terms of the support to be provided, and records of health care appointments attended. As required at the previous inspection medication was stored appropriately, and specimen signatures were available for all staff involved in administering medicines to service users. Staff were also aware that medication administration records should not be destroyed if signed in error but instead the error should be crossed through accompanied by a note explaining the error. Medication administration records, and records of receipt and disposal of medicines were complete and up to date. It is recommended that an additional symbol be introduced for use on the medication administration records to indicate that medicines were not taken for a reason other than those currently specified (accompanied by an explanation e.g. the service user was asleep).
Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The home has an appropriate complaints procedure to ensure that the concerns of service users are acted upon effectively. Procedures and training are in place to ensure that service users are protected from abuse. EVIDENCE: There have been no complaints made to the Commission about the home and none recorded in the home since the last inspection. No adult protection issues have been identified since the last inspection and the adult protection procedure for the home is of an acceptable standard. Staff have undertaken training in adult protection and addressing challenging behaviour as appropriate. Service users are generally very able to express any concerns that they have about the home, and appeared to feel safe and comfortable around staff members and management. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The home has been extended by building works improving facilities available to service users. Service users have adequate private and communal space, and the home is furnished to meet their needs. The home is kept clean, safe and well decorated to ensure service users’ comfort and protection. EVIDENCE: Building works to the home had been completed and the registered provider was successful in its application to the CSCI to increase the registration to four instead of three registered service user places. A new bedroom with en suite toilet is now provided. In addition a new bathroom and toilet had been installed on the ground floor of the home, and the lounge/dining area and kitchen had been relocated. The ground floor of the home had been redecorated and the kitchen was fitted with new units. Two service users continue to choose to share a bedroom and the empty bedroom is used as their lounge. The provider is aware that if one of these service users were to leave the home, the home would revert to three single bedrooms.
Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 17 The house was clean and tidy, and as required at the previous inspection the shared service users’ room had been redecorated, had a new carpet and curtains had been re-hung. The water temperature in the kitchen sink was of a sufficiently high temperature to ensure hygiene within the kitchen. As required, fire doors within the home were effectively self-closing. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Staff are sufficiently competent, trained and supervised to meet the needs of service users effectively. Suitable recruitment procedures are in place for all staff, to ensure the protection of service users. EVIDENCE: The rota showed one staff on duty throughout the day and one sleeping-in staff member on duty at night. This staffing level was satisfactory to meet the service users’ current needs. Inspection of four staff records, indicated that appropriate recruitment procedures are in place. They included evidence of satisfactory enhanced CRB disclosures, references, identity documents and application forms. As required a reference was being obtained from new applicants’ current or most recent employer, prior to their commencing work at the home. Records also indicated that staff receive an adequate induction before working unsupervised within the home, in addition to general mandatory training. Training courses undertaken included fire safety, adult protection, first aid, challenging behaviour, control of substances hazardous to health, diet and nutrition, and dying and bereavement. The inspector was told that health and safety training was planned for the coming year.
Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 19 It remains required that all staff undertake training in working with people with mental health problems. As required at the previous inspection, records indicated that staff members receive regular one-to-one supervision sessions with the registered manager. The staff member spoken to advised that they received adequate supervision and support from the management. As required the registered manager was in the process of completing the Registered Manager’s Award at NVQ level 4 at a local college. The registered persons are aware of the requirement for fifty percent of staff to be trained to the equivalent of NVQ level two in care. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. Service users benefit from accountable management and quality assurance systems. Their health and safety is promoted by appropriate procedures and staff training. However an inappropriate procedure for the managing of one service user’s finances may place that service user at risk. EVIDENCE: Health and safety records for the home were inspected and included appropriate gas, electricity and portable appliance testing certificates and fire safety records. As required at the previous inspection, fire doors were found to be effectively self-closing and a requirement is made accordingly. Evidence was provided that the appropriate level of liability insurance was available for the home. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 21 Service user satisfaction questionnaires had been completed by the residents of the home as part of the quality assurance procedure. Service users indicated that they were satisfied with the support they received within the home. Regular staff and service user meetings are also arranged. Inspection of service users’ finances maintained by the home indicated that appropriate support was being provided to two service users. However the inspector was concerned that one service user’s benefits were being paid into the business account for the home prior to being paid to the service user, which is in breach of the Care Homes Regulations 2001. The reason for this was that despite repeated appeals to the service user’s local authority, they had not been able to separate out monies belonging to the service user from those payable to the home. The registered person must write to the placing authority of the identified service user advising them that they are unable to receive payment of the service user’s monies into the home’s business account as this is in breach of the Care Homes Regulations (2001). Alternatives to this arrangement must be sought e.g. setting up a client account for the service user. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chesterfield Gardens 80 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 2 3 X DS0000010817.V265572.R01.S.doc Version 5.0 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA35 Regulation 18(1)(ci) 13(4)a Requirement Timescale for action 12/05/06 2 YA41 20(1) The registered person must ensure that all staff undertake training in working with people with mental health problems. (Previous timescale of 09/09/05 met regarding other training courses). The registered person must write 17/03/06 to the placing authority of the identified service user advising them that they are unable to receive payment of the service user’s monies into the home’s business account as this is in breach of Care Homes Regulations (2001). Alternatives to this arrangement must be sought e.g. setting up a client account for the service user. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 24 1 YA20 It is recommended that an additional symbol be introduced for use on the medication administration records to indicate that medicines were not taken for a reason other than those currently specified, accompanied by an explanation e.g. the service user was asleep. Chesterfield Gardens 80 DS0000010817.V265572.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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